The Value Of Angiotensin Ⅱ And D-dimer In The Assessment Of Disease And Prognosis Of Community-acquired Pneumonia

Objective:To evaluate the value of angiotensin Ⅱ(AngⅡ)and D-dimer in the severity and28-day prognosis of community-acquired pneumonia.And compared with the traditional CRP,PCT,PSI score and other indicators to explore the correlation between them.Methods:A total of 136 patients with community-acquired pneumonia treated and treated in the Department of Respiratory and Critical Care of the Second Affiliated Hospital of Nanchang University from May 2019 to March 2021 were collected.All the included patients met the diagnostic criteria of the Chinese Guidelines for the Diagnosis and Treatment of Adult Community-acquired Pneumonia(2016 Edition).According to the standard of severe pneumonia,the patients were divided into severe pneumonia group and common pneumonia group.According to PSI score,they were divided into three groups: low risk group,medium risk group and high risk group.According to the survival status at 28 days after admission,they were divided into survival group and death group.SPSS 25.0 statistical software was used to analyze and compare the differences in the levels of AngⅡ,D-dimer,PCT and CRP in the above groups.Spearman correlation analysis was used to analyze the correlation between AngⅡ,D-dimer and traditional indicators CRP,PCT and PSI.Meanwhile,ROC curve was drawn to analyze the ability of each indicator to evaluate the severity of pneumonia and to judge the prognosis.Result:1.Results: AngⅡ,D-dimer,CRP,PCT and PSI scores in severe pneumonia group were all higher than those in normal pneumonia group,with statistical significance(P < 0.001).AngⅡ,D-dimer,CRP,PCT and PSI scores in the death group were higher than those in the survival group,and the differences were statistically significant(P < 0.001).2.The levels of AngⅡ,D-dimer,PCT and CRP in different PSI groups were compared.Generally,the levels of AngⅡ,D-dimer,PCT and CRP showed an increasing trend with the increase of PSI rating.After pairwise comparison among the three groups,it was found that the differences in AngⅡ levels were statistically significant between the low-risk group-medium risk group and the low-risk group-high risk group(P < 0.05),while there was no statistical significance between the medium-risk group-high risk group(P > 0.05).The level of D-dimer in the low-risk group,medium-risk group and high-risk group was statistically different in pairwise comparison(P < 0.05).There was statistically significant difference in PCT level between low-risk group-high risk group and medium-risk group-high risk group(P < 0.05),while there was no statistically significant difference between low-risk group-medium risk group(P > 0.05).There were statistically significant differences in CRP levels between low-risk group-medium risk group and low-risk group-high risk group(P < 0.05),while there was no statistically significant difference between medium-risk group-high risk group(P > 0.05).3.The correlation analysis between AngⅡ,D-dimer and CRP,PCT and PSI indicated that AngⅡ was positively correlated with CRP,PCT and PSI(r = 0.432,0.478,0.499,P < 0.001).D-dimer was positively correlated with PSI(r = 0.481,P <0.001),CRP and PCT(r = 0.301,0.280,P < 0.001).4.ROC curve was used to analyze the predictive ability of PSI score,D-dimer,AngⅡ,CRP and PCT on the severity of disease in patients with community-acquired pneumonia.The maximum area(AUC)under each index curve were 0.860,0.834,0.813,0.712,0.689,and the optimal cut-off values were 94 points,2.095ug/m L,87.175pg/ m L,99.825mg/L,0.335ng/ m L,respectively.The corresponding sensitivity was 80.9%,70.6%,70.1%,59.8%,69.1%,respectively.The corresponding specificity were 77.9%,86.7%,85.8%,84.4%,61.8%,respectively.5.ROC curve was used to analyze the predictive power of PSI score,D-dimer,CRP,AngⅡ,and PCT on 28-day mortality risk in patients with community-acquired pneumonia.The maximum area(AUC)under each index curve were 0.844,0.788,0.783,0.705,0.646,the optimal cut-off values were 113 points,2.94ug/ml,103.64mg/L,103.467pg/ml,2.49 ng/ml,and the corresponding sensitivity were 88%,76%,80%,72%,48%,respectively.The corresponding specificity were 67.6%,74.8%,76.6%,65.8%,81.1%,respectively.Conclusions:1.AngⅡ and D-dimer can be used for community-acquired pneumonia condition assessment and prognosis prediction.2.AngⅡ is positively correlated with traditional inflammation indicators CRP and PCT,suggesting that AngⅡ will be expected to become a new biomarker used in clinical practice.D-dimer is weakly positively correlated with CRP and PCT,potentially The value is limited.